11386 (RPL){ P.O. BOX 1504
N o. 11000
Building 54-•175 SOUTHERN HILLS 78-105 CALLE ESTADO `
Address LA QUINTA, CALIFORNIA-92253
Owner
HAMILTON
.
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address SAME
A.P. Number
" CityZip
Tel.
LA-QUINTA
92253
771.--1540
Legal Description
Contractor J
Project Description
POOL AND SPA
CALIFORNIA POOLS AND SPAS
Address _w
41910 BOARDWALK A —
City..
Zip
Tel.:
t
PALM'DESERT
922,60
340-9000
State Lic.
City
& Classif. C53 155.182
LiC. # 3.55
sq. Ft.
No. No. DW.
Size.
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair.❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
' LICENSED CONTRACTOR'S DECLARATION
I;herebyy affirm that I am,licensed under.provisions of Chapter 9 (commencing with Section '
000) of•Division 3 ofithe.Businne";s-an'd;Profe-s6lons-Code, and my license is in full force and
Veffect. i
SIGNATURE "• - DATE
OWNER-BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am'ezempt.from the Contractors License Law for the: following
Q 1s 500
$
reason: (Sec. 7031.5, Business. and Professions. Code._ Any city or county which requires a
'permit.
to construct, alter, improve, demolish, or repair any structure, pnor to its issuance also•
' .requires the applicant for such permit to rile a signed statement that he � is licensed pursuant. to .
.PERMIT � -
- 1
AMOUNT
the provisions of the Contractor's License Law, Chapter. 9 (commencing with section 7000) of
-
Division 3 of the Business and'Prolessions Code,, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
Plan Chk. Dep.
'
- - .
subjects more rive the applicant to a civil penalty of not than hundred.dollars.($500)..' -
Plan Chk. BBI.
yi '
990'45
❑ 1, as owner of the property, or my employees with wages as their-sole compensation, will
' do the work, and the structure is not intended or offered for sale. (Sec. 7044,. Buisness and
Const.
J51.00
;Professions Code: The Contractor's License Law does not apply to an owner of properly who .
builds or improves thereon and who does such workhimself or through his own employees,
Mebh._
24.00
provided that'-such improvements .are not intended or offered. tor.' sale. ff,' however, the building-
,or improvement is sold within one. year of completion, the owner-builder will have the burden
Electrical
45.700
-� of proving that he did not build or improve.. for the purpose of sale.) , • .
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- .
Plumbing. ..
27.00.
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License .Law
does: not apply to an owner of builds or improves thereon, and who contracts for �
S.M.I.
P�
1..40 '
property%.who
-such projects with a contractors) licensed pursuant to the Contractor's License Law.) , -
:.. -
Grading
-
O I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I hereby,affirm that 1-have a"certificate of consent to self-insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof.•(Sec. 3800; Labor Code.)
.,,Policy No. ' ,`0 Company
Copy is filed with the city. ..❑ Certified copy is hereby furnished.
I
TOTAL
$349.85
CERTIFICATE OF EXEMPTION FROM
REMARKS '
r�7�
� ; �.�f i;j ;-L J � �t!" � x Cr 4j. NJ"
WORKERS' COMPENSATION INSURANCE '
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) . - .. .... ..
....�
I certify that in the performance of thg work for which-this permit is issued; I shall not
employ any person in any manner so as to become subject to'the Workers' Compensation
Laws of California r
Date Owner " r
' NOTICE TO APPLICANT: If, after making • this, Certificate of Exemption you should become
ZONE: -
BY: .�1 -
subject to the- Workers' Compensation provisions .of the Labor Code; you must-forthwiur
comply with such provisions or this permit shall be deemed revoked. ,,�
Minimum Setback Distances: '
_ -
Front Setback from Center Line
Rear Setback from Rear Prop. Line '
CONSTRUCTION LENDING AGENCY.
r
Side Street Setback: from Center Line"
I hereby affirm that there is a construction lending agency for the performance of the
work, for which this permit is issued. (Sec. 3097, Civil Code.) _ -
Side Setback from Property Line -
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration If work thereunder is suspended for 180 days. .
I certify that I have read this application and state that the. above information is correct:,ISSUed
'comply
by:
Date Permit
I agree towith all city and county ordinances and. state laws relating, to building
construction,.and hereby authorize representatives :of this city to :enter the above..'
.mentioned property for inspection purposes.
Validated.by:
• Signature of applicant Date
,• Mailing Address
Validation:
City, State, Zip
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING-JEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE IDRYER
AL INSP `lkk J
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3yic
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR-
SETBACK
OLAR-
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
AL INSP `lkk J
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
ARCRZTECTIIRAL APPROVAL APPLICATION.
ALL CONSTRUCTION DEBRIS CREATED -BY THIS MODITICATION
Vm MUST HE REMOVED FROM THE COMPLEX DAILY
i
POs ■W sE =ffK ALiO0CIM OIG
Date ';
Homeowner ApplicantHame(s)' 'te'A `a
Address �c1�o �A,�►,JC�S�(��`SFi�'T �cr2Tt-� �TE7�A5 .7 46
(Primary Resiaencel
Telephone
c (PGA West) (Long Distancef
PGA West Address `-� ti-' 1=7-5='��JrtaER= �t±S Tract -2`i3Z-� Lot
Modification(s) Requested ^M%62A.ap 1N'STA1_L__
N ELS 1^'0 0 S t�A } P P.N D tom• R Q :•a La-Z: E ?E 2
JON
Work Schedule Commencement Date AS�� Completion Data 1 y - 3 ) Z
Contractor (s)
To THE ARCHITECTURAL COMMITTEE:* ,
You are hereby advised that the above work is proposed and•approval is requested. Attached
is a drawing of the work to be done and types of materials to be used as indicated on the
drawings. We understand that'.buildinq permits for home improvements are required by, the
City of La Quina and that the cost of the -permits and responsibility of obtaininq permits
and subsequent' -inspection will be borne by the applicant.
We acknowledge'• that. all approved changes in the orig4Aal design will be at our expense;
that any and. all damage to. building- structure, or other damage resulting from the
constzzction of the proposed improvement shall be at our (owner's) expense. Additionally,
any maintenance of the permitted improvements shall " at the applicant's expense and the
applicant agrees to hold the PGA West Residential Association, harmless for the cost of
maintenance of same . Homeowner,agrees to indemnify, defend and hold harmless PGA Wast
Residential -Association, its officers, agents and employees from any liability arisihq from
execution of this application.
Signatures of
all owners ` O GL/,`" �oR $.6, i�s�FZR�•i TW:STs:� Fol
M•g •HAM�►_Tq�.1T�JST
ARCHITECTURAL CONTROL COMMITTEE
Approved Conditionally Approved Disapproved
Reason for Conditional Approval or Disapproval
Date Q I I Qy Signature�1 P
—Arcnitectural Controi Committee Chairman
In addition to this approval, you must obtain City approval for'the requested modification
as Weil as any other necessary building permits. You are required, to submit evidence ,of
the Association approval to obtain the building permit. For this purpose, all blueprints•
ane plans will be embossed with •the Association' s. seal, .the signature of .the Property
Manager,' and the date of the.approval. '
Compieted Work Signed off by' Date